Careers in Toxicology within the NHS
Analytical toxicology is concerned with the role of the laboratory in the diagnosis, treatment and, if possible, prevention of poisoning.
Analytical toxicology in the NHS is a recognised subspecialty of Clinical Biochemistry. This is because many routine clinical chemical tests are important in the diagnosis of acute poisoning and in detecting adverse drug reactions, and in monitoring the treatment of the poisoned patient. Moreover, some commonly requested toxicology test such as serum lithium and plasma paracetamol are best offered on an emergency (24-hour) basis by clinical biochemistry departments.
There are however a huge range of more specialised toxicology tests that are best handled by dedicated sections within clinical biochemistry departments. Added to this the interpretation of test results, a very important part of all clinical laboratory medicine, can be especially complex in the case of toxicological analyses. Finally, the equipment needed to perform certain tests is expensive and in order to make best use of resources is often situated in such sections. There is much emphasis on gas-liquid and/or high performance liquid chromatography often in association with mass spectrometry (GC-MS, LC-MS) and on inductively-coupled mass spectrometry (ICP-MS) in modern toxicology laboratories.
The testing provided in NHS toxicology laboratories falls into 4 main areas, viz. clinical or overdose toxicology, which may in some laboratories include performing work on behalf of HM Coroner or the Procurator Fiscal in Scotland, specialised therapeutic drug monitoring, drugs of abuse screening, and toxic metals/trace element monitoring. There are many variants on these general areas. In all cases there is much overlap with forensic toxicology. i.e. toxicology in the service of the Courts.
Training to provide analytical toxicology services is by definition a specialist area within clinical biochemistry and is provided at the Higher Specialist Training (HST) level to selected entrants who have completed successfully the Modernising Scientific Careers (MSC) Life Sciences training programme. A detailed HST syllabus and associated exit examination have been prepared under the auspices of the Royal College of Pathologists (RCPath). Success in the exit examination will be marked by Fellowship of the RCPath and admission to the planned HSST register to be maintained by the Academy for Healthcare Science (AHCS).
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